"Doctor, my hair feels different, and I'm having more trouble keeping weight off. Could you check my thyroid?" This is one of the most common conversations I have with patients. Thyroid issues are a real phenomenon. I compare the thyroid gland to the accelerator on a car. If the accelerator is pushed down too far, all functions speed up: weight loss, increased metabolism, tremor, fast heart rate, bulging eyes and heat intolerance. All the symptoms of hyperthyroidism. If the accelerator is not pushed down enough, on the other hand, everything runs slowly (hypothyroidism): constipation, fatigue, slow heart rate, cold intolerance, depression and lowered metabolism. It also causes heart problems and depression. Not a set of changes that make for a happy life!
Fortunately, both syndromes are easy to diagnose, and, most of the time, the treatment works wonders.
In hypothyroidism, your physician can do a blood test that looks for a low-functioning thyroid gland. Scientists have developed a way to put thyroid hormone into a pill. Those whose thyroid gland does not produce enough can easily take the hormone by mouth. Clean and simple.
The thyroid hormone, called thyroxine, is a peculiar molecule. After ingested, it finds its way to the thyroid gland, located in the lower front part of the neck, where it is stored. It will remain there for one to two months before being used. What that means for treatment is that when we choose a thyroxine dose, we have to wait two months before checking blood levels again to determine if we are taking the correct amount. Most of the time, we get our patients to steady-state dosing within four to six months.
For most sufferers, the cause of the thyroid gland's demise is a syndrome called Hashimoto's Thyroiditis. This is an auto-immune process, which means that the person's immune system unexpectedly attacks the thyroid gland. Not very nice. The process is painless, and most never know it is going on until months later when they develop low thyroid symptoms.
Before we Americans began putting iodine in our salt, iodine-deficiency was the most common cause of hypothyroidism. It still is in the rest of the world. Iodine is required to make thyroid hormone. Without it, the thyroid gland under-produces and attempts to make up for this lost production by growing.
This phenomenon is called a goiter. The term goiter comes from the Latin gutter, which means throat. A goiter can result from any cause of hypothyroidism. It can also develop from an over-functioning gland. Goiters cause problems when the gland gets too big and pushes on important structures like the trachea or large blood vessels in the neck. I usually send these folks to a good surgeon for thyroid gland removal.
Hypothyroidism's mirrored counterpart, hyperthyroidism, is less common. If hypothyroidism is a tortoise, hyperthyroidism is the hare. An over-producing thyroid gland is most commonly caused by Grave's Disease. Grave's is also an auto-immune disorder, but instead of attacking and destroying the gland, it stimulates it to make too much hormone. Typically, I will start these folks on a medicine that keeps their heart rate from increasing too much and send them to an endocrinologist. The specialist can destroy the gland with radioactive iodine (sounds scary but works great and is safe) or send the person for surgical thyroid removal. After this process, the patient must take supplemental thyroid hormone to make up for the missing gland.
Occasionally, one of my patients will present with a lump on his or her thyroid gland. Of course, the concern is the possibility that the mass is cancer. Thankfully, only small fractions are, and most are benign nodules that we leave alone. The majority of thyroid cancers, though, are completely curable. Since thyroid masses are so easily seen on the neck, we catch them early. If you do develop a neck mass, see your physician right away. A simple, safe needle biopsy gives us all the data we need.
How amazing that one dysfunctional little gland in the neck can create such mayhem. It is like the ship's rudder: small but influential. Watch for its symptoms, and you should be able to enjoy good thyroid health.
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